Blunt use among Florida teens declined from 2010-2015 then reversed, rising sharply through 2020

Past and current blunt use declined from 2010 to 2015 (APC = -5.32% and -5.28%), but current use increased from 2015 to 2018 (APC = 14.91%) before leveling off. Rising trends were especially pronounced among female students (APC = 14.92%), middle schoolers (APC = 19.57%), and non-Hispanic white students (APC = 11.12%) from 2016 to 2020. Use of cigarettes, e-cigarettes, hookah, cigars, and vaping marijuana were all associated with blunt use.

Analysis of 2010-2020 cross-sectional, statewide representative Florida Youth Tobacco Surveys comprising 461,706 middle and high school students. Joinpoint regression calculated annual percentage change in blunt use prevalence. Multivariable regression using 2019-2020 data examined associated factors.

Blunts combine tobacco (from the cigar wrapper) with marijuana, exposing users to both substances. The reversal in declining trends and spread to new demographic groups suggests that existing tobacco prevention programs have not adequately addressed blunt use.

The demographic shift in blunt use, with increases among girls, younger students, and white youth, suggests the behavior is diffusing beyond its historical concentration among older male and Black students, requiring broader prevention messaging.

Florida data may not generalize to other states. Self-reported data in school settings may underestimate use. Cross-sectional surveys cannot track individual trajectories. Blunt definition may vary among respondents.